Transcript Hem/Onc Tumor Board Presentation

Hem/Onc Tumor Board
Presentation
Advanced Topics in Cancer Biology
Katy Van Hook
June 3, 2009
MA 32 y/o female
• 12/08 she is seen for epigastric pain, night
sweats, and nausea
– 28 weeks pregnant
• Symptoms persist and she receives an
abdominal ultra sound
– Enlarged spleen (14 x 12.7 x 5.7 cm)
– Innumerable variable-sized relatively well
circumscribed hyperechoic lesions
MA 32 y/o female
• CT
– Multiple lesions in the
spleen
• Flow cytometry of
peripheral blood
lymphocytes was
normal suggesting that
it is not lymphoma
– Just watch
MA 32 y/o female
• Delivers baby (#9!) on 3/5/09
• 3/28/09 her condition improves but is still having
night sweats
• History of malaria, + PPD, parasites, etc…
– Normal labs except for mild thrombocytopenia (low
platelet count)
– She is immunized for an encapsulated organism
• Infection? Marginal zone lymphoma? Metastatic
disease?
• Surgery vs. Biopsy
Pathology
• No evidence of lymphoma
– CD3 (T cell) CD20 (B cell) are
normal
– Weakened D2-40
• Dilated vascular spaces lined
by flattened endothelial cells
• Lots of red blood cells
• Vascular lesion
– Hemangioma or
lymphangioma
• Looks benign
• Splenic lesions
– 57% lymphoma
– 7% benign of malignant
vascular neoplasm
Internet Journal of Pathology vol 8 no. 1
Hemangioma
Hemangioma
• Benign tumor of endothelial cells that
line the blood vessels
• Most common childhood tumor
affecting 10% of Caucasians
• Most common sites are face and neck
Splenic hemangiomas
• The most common primary splenic
neoplasm
• Incidence between 0.03%-14% at
autoposy
• Malginant transformation is extremely
rare
Lymphangioma
Childhood Lymphangioma
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Benign hyperplasia of lymphatic vessels
6% of benign tumors in children
Most common sites are face and neck
Thought to be a developmental malformation
Adult Lymphangioma
• VERY rare in adults
• Lymphatic vessel with
proliferative behavior
• Initial lymphatics that
never fully form
• Initiated by injury or
infection? Dysregulated GF?
Mechanisms are relatively unknown
Lymphangioma
• Elevated expression of
VEGR2/3, and VEGF-C
Hemangioma
• Elevated expression of
VEGF and fibroblast
growth factor (FGF)
BMC Cancer (2007) 7:105
Treatment options
• No treatment-monitor patient
– Risk of rupture
– Compression of other organs
• Splenectomy
• Embolization
– Polyvinyl alcohol calibrated spheres
• Vascular growth inhibitors
– VEGF inhibition has been suggested studies are
ongoing
References
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Fagen K, et al. (2008) JVIR 20:559-560
Wiegand S., et al. (2008) Virchows Arch 453:1
Norgall S., et al. (2007) BMC Cancer 7:105
Willcox TM. et al. (2000) J Gastrointest Surg
4:611-613
• Disler DG and Chew FS. (1991) AJR 157:44
• Internet Journal of Pathology. Vol. 8 no. 1